Challenges and potential solutions for big data implementations in developing countries

BACKGROUND

The volume of data, the velocity with which they are generated, and their variety and lack of structure hinder their use. This creates the need to change the way information is captured, stored, processed, and analyzed, leading to the paradigm shift called Big Data.

OBJECTIVES

To describe the challenges and possible solutions for developing countries when implementing Big Data projects in the health sector.

METHODS

A non-systematic review of the literature was performed in PubMed and Google Scholar. The following keywords were used: "big data", "developing countries", "data mining", "health information systems", and "computing methodologies". A thematic review of selected articles was performed.

RESULTS

There are challenges when implementing any Big Data program including exponential growth of data, special infrastructure needs, need for a trained workforce, need to agree on interoperability standards, privacy and security issues, and the need to include people, processes, and policies to ensure their adoption. Developing countries have particular characteristics that hinder further development of these projects.

CONCLUSIONS

The advent of Big Data promises great opportunities for the healthcare field. In this article, we attempt to describe the challenges developing countries would face and enumerate the options to be used to achieve successful implementations of Big Data programs.

Health Informatics in Developing Countries: Systematic Review of Reviews Contribution of the IMIA Working Group Health Informatics for Development

Objectives: An evidence-base is important for medicine and health informatics. Despite numerous publications showing the benefits of health informatics, the emergence of health information systems in developing countries has been slower than expected. The aim of this paper is to identify systematic reviews on the domain of health informatics in developing countries, and classify the different types of applications covered.

Methods: A systematic review of reviews was conducted. The literature search spanned the time period between 2000 and 2012 and included PubMed, EMBASE, CINAHL, Scopus, Cochrane Systematic Reviews, LILACS, and Google Scholar. The search term was ‘systematic reviews of health informatics in developing countries’, and transparent and systematic procedures were applied to limit bias at all stages.

Results: Of the 982 identified articles, only 10 met the inclusion criteria and one more article was added in a second manual search, resulting in a total of 11 systematic reviews for the analysis.

Conclusions: Although it was difficult to find high quality resources on the selected domain, the best evidence available allowed us to generate this report and create an incipient review of the state of the art in health informatics in the developing countries. More studies will be needed to optimize the results.

Health Informatics in Developing Countries: Systematic Review of Reviews. Contribution of the IMIA Working Group Health Informatics for Development

OBJECTIVES

An evidence-base is important for medicine and health informatics. Despite numerous publications showing the benefits of health informatics, the emergence of health information systems in developing countries has been slower than expected. The aim of this paper is to identify systematic reviews on the domain of health informatics in developing countries, and classify the different types of applications covered.

METHODS

A systematic review of reviews was conducted. The literature search spanned the time period between 2000 and 2012 and included PubMed, EMBASE, CINAHL, Scopus, Cochrane Systematic Reviews, LILACS, and Google Scholar. The search term was 'systematic reviews of health informatics in developing countries', and transparent and systematic procedures were applied to limit bias at all stages.

RESULTS

Of the 982 identified articles, only 10 met the inclusion criteria and one more article was added in a second manual search, resulting in a total of 11 systematic reviews for the analysis.

CONCLUSIONS

Although it was difficult to find high quality resources on the selected domain, the best evidence available allowed us to generate this report and create an incipient review of the state of the art in health informatics in the developing countries. More studies will be needed to optimize the results.

Health Informatics for Development: a Threepronged Strategy of Partnerships, Standards, and Mobile Health

Describe the issues surrounding health informatics in developing countries and the challenges faced by practitioners in building internal capacity. From these issues, the authors propose cost-effective strategies that can fast track health informatics development in these low to medium income countries (LMICs).

The authors conducted a review of literature and consulted key opinion leaders who have experience with health informatics implementations around the world.

Despite geographic and cultural differences, many LMICs share similar challenges and opportunities in developing health informatics.

Partnerships, standards, and inter-operability are well known components of successful informatics programs. Establishing partnerships can be comprised of formal inter-institutional collaborations on training and research, collaborative open source software development, and effective use of social networking. Lacking legacy systems, LMICs can discuss standards and inter-operability more openly and have greater potential for success. Lastly, since cellphones are pervasive in developing countries, they can be leveraged as access points for delivering and documenting health services in remote under-served areas. Mobile health or mHealth gives LMICs a unique opportunity to leapfrog through most issues that have plagued health informaticsin developed countries. By employing this proposed roadmap, LMICs can now develop capacity for health informaticsusing appropriate and cost-effective technologies.

Health Informatics for Development: a Three-pronged Strategy of Partnerships, Standards, and Mobile Health. Contribution of the IMIA Working Group on Health Informatics for Development

OBJECTIVE

Describe the issues surrounding health informatics in developing countries and the challenges faced by practitioners in building internal capacity. From these issues, the authors propose cost-effective strategies that can fast track health informatics development in these low to medium income countries (LMICs).

METHODS

The authors conducted a review of literature and consulted key opinion leaders who have experience with health informatics implementations around the world.

RESULTS

Despite geographic and cultural differences, many LMICs share similar challenges and opportunities in developing health informatics.

CONCLUSIONS

Partnerships, standards, and inter-operability are well known components of successful informatics programs. Establishing partnerships can be comprised of formal inter-institutional collaborations on training and research, collaborative open source software development, and effective use of social networking. Lacking legacy systems, LMICs can discuss standards and inter-operability more openly and have greater potential for success. Lastly, since cellphones are pervasive in developing countries, they can be leveraged as access points for delivering and documenting health services in remote under-served areas. Mobile health or mHealth gives LMICs a unique opportunity to leapfrog through most issues that have plagued health informatics in developed countries. By employing this proposed roadmap, LMICs can now develop capacity for health informatics using appropriate and cost-effective technologies.

A medical informatics distance-learning course for Latin America. Translation, implementation and evaluation

BACKGROUND

There is a growing need and interest worldwide for healthcare and information technology professionals trained in medical informatics. Distance learning technologies are increasingly used to deliver such education, but have mainly been limited to the English language.

OBJECTIVE

Describe the implementation and student satisfaction of a medical informatics course delivered in Spanish for a Latin American audience.

METHODS

The course was based on the 10 x 10 program of the American Medical Informatics Association and Oregon Health & Science University that was translated and adapted to the Latin American setting. The initial course consisted of ten one-week units, currently the course has 15 modules that are delivered in 16 weeks with topics that address the needs of medical informatics in the region. We also administered an anonymous questionnaire of student satisfaction.

RESULTS

A total of 499 individuals have enrolled in the course, and 70% have completed it. Most of the students have been healthcare professionals (86%), with the largest proportion from Argentina. Student satisfaction with all aspects of the course was high. After the initial experience and feedback from the students, the course has been adapted to better meet regional needs.

CONCLUSION

The initial experience obtained in training healthcare professionals in medical informatics in Latin America in their own language demonstrated that it could be used across the region, and this could represent a model for disseminating knowledge of medical informatics across other languages and cultures.

336 MEIOTIC DEVELOPMENT AND CORTICAL GRANULES DISTRIBUTION IN CANINE OOCYTES DURING IN VITRO MATURATION

Low development of IVM canine oocytes could be in part attributed to an impaired cytoplasmic maturation. In mammalian oocytes, migration and the redistribution of cortical granules (CGs) around the periphery of the oocyte contribute to the inhibition of polyspermy and it is an important criterion to evaluate cytoplasmic maturation. The state of nuclear maturation and the distribution of CGs were evaluated in canine oocytes cultured for different periods in order to compare the synchrony of nuclear and cytoplasmic maturation during in vitro maturation. Bitch ovaries at different stages of the estrous cycle were obtained following ovariectomy. COCs with compact cumulus cells showing a homogeneous cytoplasm were selected for experiments. Thirty-six COCs were processed at immature stage, placed in PBS medium until evaluation. A total of 275 COCs were matured in vitro for 48, 72, and 96 h in TCM-199 with Earle’s salt supplemented with 25 mM Hepes, 10% FCS, 0.25 mM pyruvate, 10 IU mL-1 of hCG, 300 IU mL-1 penicillin, and 20 mg mL-1 streptomycin, at 38.5°C and 5% CO2. At each culture period, the oocytes were stained with Lens culinaris agglutinin (LCA), labeled with fluorescein isothiocyanate, and the CGs distributions were examined under a fluorescent microscope. The nuclear status of the denuded oocytes was determined by DAPI staining under a fluorescence microscope. For each treatment, at least four replicates were performed and the data was analyzed by ANOVA using Tukey’s test to determine the differences P < 0.05. Three types of CGs distribution were distinguished during canine oocyte maturation: (1) homogeneous distribution throughout the cytoplasm including the cortex; (2) heterogeneous (clusters) within the cytoplasm and (3) densely distributed beneath the oolemma. Nuclear stages were classified as immature or germinal vesicle (GV) stage; resumption of meiosis or germinal vesicle break down (GVBD); metaphase I to telophase I (MI toTel I); and mature or second metaphase (MII). The distribution patterns of GCs were different (P < 0.05) among oocytes cultured for different periods and the nuclear maturation status also differed between oocytes cultured for different intervals (P < 0.05). Most (>84%) of the immature oocytes at GV showed a uniform distribution of CGs throughout the cytoplasm. At 48 h of culture, CGs distribution was mainly Type 2 (25%) and 3 (61%) and the oocytes were at GVBD (33%) and MI-Tel I (33%) stages. Most nuclei of the type 3 oocytes were in the MI (40%) and MII (11%) stages, corresponding to those oocytes matured for 72 (88%) or 96 h (71%). These results indicate that canine oocytes migrate to the cortex during IVM and this process is not finished before 72 h of culture. In addition, although the re-distribution of the CGs occurred in parallel with nuclear maturation, the oocytes cannot always proceed to the MII stage; however, in such oocytes the CGs are distributed beneath the oolemma. Supported by Grant FONDECYT 1080618.

Implementing rules to improve the quality of concept post-coordination with SNOMED CT

The use of SNOMED CT as a standard reference terminology enables interoperability between clinical systems. This reference tool provides a method for creating post-coordinated terms by users according to local needs. While the creation of these terms is free, there are a number of rules, as defined in the user manual of SNOMED CT that must be followed.The Hospital Italiano of Buenos Aires has a Terminology Server that encodes medical terms, using SNOMED CT as the reference vocabulary. An interoperability analysis performed with the Nebraska Medical Center in 2006 found a high error rate (26%) in post-coordinated terms. Therefore, we implemented an automatic system of rules within the Terminology Server as defined in the user manual. Following rules implementation, the error rate decreased from 26% to 2%.

Spreading Knowledge in Medical Informatics: the Contribution of the Hospital Italiano de Buenos Aires

Medical Informatics (MI) is an emerging discipline with a high need of trained and skillful professionals.

Objective To describe the educational experience of the Department of Health Informatics of the Hospital Italiano de Buenos Aires.

Methods A descriptive study of the development of the Medical Informatics Residency Program (MIRP) and the e-learning courses related to medical informatics.

Results A four-year MIRP with 15 rotations was started in 2000, and was awarded national educational accreditation. Eight residents have been fully trained and their main academic contributions are shown in this study.

The e-learning courses related to medical informatics (Healthcare Management, Epidemiology & Biostatistics, Information Retrieval, Computer Literacy started, 10x10 Spanish version and HL7 introductory course) started in 2006 and were followed by more than 2266 students from all over the world, with an increase trend in foreign students.

Conclusions These educational activities have produced skilled human resources for the development and maintenance of the health informatics projects at our Hospital. In parallel, the number of students trained by e-learning continues to increase, demonstrating the worldwide need of knowledge in this field.

Spreading knowledge in medical informatics: the contribution of the hospital Italiano de Buenos Aires

Medical Informatics (MI) is an emerging discipline with a high need of trained and skillful professionals.

OBJECTIVE

To describe the educational experience of the Department of Health Informatics of the Hospital Italiano de Buenos Aires.

METHODS

A descriptive study of the development of the Medical Informatics Residency Program (MIRP) and the e-learning courses related to medical informatics.

RESULTS

A four-year MIRP with 15 rotations was started in 2000, and was awarded national educational accreditation. Eight residents have been fully trained and their main academic contributions are shown in this study. The e-learning courses related to medical informatics (Healthcare Management, Epidemiology & Biostatistics, Information Retrieval, Computer Literacy started, 10x10 Spanish version and HL7 introductory course) started in 2006 and were followed by more than 2266 students from all over the world, with an increase trend in foreign students.

CONCLUSIONS

These educational activities have produced skilled human resources for the development and maintenance of the health informatics projects at our Hospital. In parallel, the number of students trained by e-learning continues to increase, demonstrating the worldwide need of knowledge in this field.

Bilateral lacrimal sac mucocele with punctal and canalicular atresia

Congenital absence of lacrimal puncta may be an isolated finding or associated with other developmental abnormality. Nasolacrirnal ducts can be absent thus predisposing to the formation of a congenital lacrimal mucocele. Punctal and canalicular agenesis is very rare. Four percent of new patients attending the lacrimal clinic at Moorfields Eye Hospital, London, UK. from 1981 to 1990 inclusive were diagnosed to have this condition. We describe a case of bilateral congenital absence of lacrimal puncta with lacrimal mucocele. Combined surgery was carried out by Ophthalmologist and Otolaryngologist with successful results.

[Neurological aspects of ceroid-lipofuscinoses]

OBJECTIVE

We discuss the historical, epidemiological, clinical, complementary tests and neuropathological details of ceroid-lipofuscinoses in children.

DEVELOPMENT

Initially, we review the basic concepts and historical details of the disorders, and the frequency and distribution of the different clinical forms. Subsequently, we review the subtypes and variants most commonly found in children, together with the elements necessary for diagnosis. Finally we analyze the neuropathological studies and their clinical correlation.

CONCLUSIONS

The clinical diagnosis of ceroid-lipofuscinoses should be based on a clinical history showing disorders of vision, convulsions and regression of psychomotor functions. Neuroimaging findings, neurophysiological changes and ultrastructural studies confirm the diagnosis.

Genome search for susceptibility loci of common idiopathic generalised epilepsies

Genetic factors play a major role in the aetiology of idiopathic generalised epilepsies (IGEs). The present genome scan was designed to identify susceptibility loci that predispose to a spectrum of common IGE syndromes. Our collaborative study included 130 IGE-multiplex families ascertained through a proband with either an idiopathic absence epilepsy or juvenile myoclonic epilepsy, and one or more siblings affected by an IGE trait. In total, 413 microsatellite polymorphisms were genotyped in 617 family members. Non-parametric multipoint linkage analysis, using the GeneHunter program, provided significant evidence for a novel IGE susceptibility locus on chromosome 3q26 (Z(NPL) = 4.19 at D3S3725; P = 0.000017) and suggestive evidence for two IGE loci on chromosome 14q23 (Z(NPL) = 3.28 at D14S63; P = 0.000566), and chromosome 2q36 (Z(NPL) = 2.98 at D2S1371; P = 0.000535). The present linkage findings provide suggestive evidence that at least three genetic factors confer susceptibility to generalised seizures in a broad spectrum of IGE syndromes. The chromosomal segments identified harbour several genes involved in the regulation of neuronal ion influx which are plausible candidates for mutation screening.

[Prolonged bradyarrhythmias after coronary revascularization surgery]

The authors report four cases of prolonged bradyarrhythmias after isolated coronary artery bypass graft surgery. All the four patients required permanent pacemaker implantation. Etiologic factors of conduction disturbances after coronary artery bypass and long term follow-up are discussed.

Stiparin: a glycoprotein from sea cucumber dermis that aggregates collagen fibrils

The interactions between collagen fibrils in many echinoderm connective tissues are rapidly altered by the secretions of resident neurosecretory cells. Recent evidence has suggested that a secreted protein is responsible for the interactions that lead to an increase in tissue stiffness (Trotter and Koob, 1995). Structurally intact collagen fibrils have been isolated from such a connective tissue- the dermis of the sea cucumber Cucumaria frondosa- and used in an assay in vitro to identify a protein that binds to them and causes them to aggregate. This protein has been purified by anion-exchange and molecular sieve chromatography. It is eluted from a MonoQ column at approximately 0.55 M NaCl. Its isoelectric point is 5.2. It elutes from a Superose-6 column in a position corresponding to a molecule with a Stokes radius of 11.5 nm. Its native molecular weight estimated from sedimentation equilibrium analysis under non-denaturing conditions is 375,000, and its monomer molecular weight, estimated by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate, is approximately 350,000. Sedimentation velocity measurements indicated for the native molecule a sedimentation coefficient of 11 x 10(-13)s, a diffusion coefficient of 3.274 x 10(-7) cm2s-1, and a frictional ratio of 1.95, which corresponds to a prolate ellipsoid of revolution with an axial ratio of 19. The highly asymmetric structure suggested by the above correlated well with the images obtained by transmission electron microscopy following rotary shadowing, which revealed a flexible structure approximately 125 nm long. Based on its ability to aggregate collagen fibrils, this protein has been named "stiparin," from the Latin stipare, "to pack together."